E-ISSN 1305-3612
Abdominal Imaging - Original Article
Low tube voltage increases the diagnostic performance of dual-energy computed tomography in patients with acute appendicitis
1 Clinic of Radiology, Ağrı State Hospital, Ağrı, Turkey  
2 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey  
Diagn Interv Radiol ; : -

Abstract

PURPOSE: To assess the utility of dual-energy computed tomography (DECT) imaging in diagnosing acute appendicitis (AA) with density measurements of the appendix vermiformis.

 

METHODS: A total of 210 consecutive patients presenting with acute abdominal pain were scanned using a DECT system between January and October 2016. Twenty-six patients had pathologically confirmed AA, while 30 had normal appendices. Appendiceal densities were measured in the true axial section of the appendix vermiformis at 80 kilovoltage peak (kVp), 140 kVp, virtual non-contrast, iodine overlay, mixed, and monoenergetic (40, 50, 60, 70, 80, 90, 100 kiloelectronvolt [keV]) images.

 

RESULTS: Comparison of the appendix at different kVp and keV energy levels, virtual non-contrast, iodine overlay, and mixed images yielded significant differences between patients with appendicitis and those with a normal appendix (P < 0.001 for all). Receiver operating characteristic (ROC) curve analysis revealed that the 80 kVp image set yielded the best diagnostic performance (area under the ROC curve [AUC] 0.996; P < 0.001) among all image sets, while 70 keV images yielded the highest diagnostic performance among the virtual monoenergetic image sets (AUC 0.958; P < 0.001). Inter-rater agreement was good at 80 kVp images (Intraclass correlation coefficient [ICC]=0.78, P < 0.001).

 

CONCLUSION: Evaluation of DECT image reconstructions suggested that low tube-voltage with 80 kVp demonstrated accurate diagnostic performance for AA. This finding suggests that low kVp CT may be useful for diagnosing AA with reduced patient radiation exposure.

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